Provider Demographics
NPI:1578548525
Name:VENNAMANENI, SRIDHAR R (MD)
Entity Type:Individual
Prefix:DR
First Name:SRIDHAR
Middle Name:R
Last Name:VENNAMANENI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1552 PALM BEACH LAKES BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-2302
Mailing Address - Country:US
Mailing Address - Phone:561-659-7411
Mailing Address - Fax:561-659-7423
Practice Address - Street 1:1552 PALM BEACH LAKES BLVD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-2302
Practice Address - Country:US
Practice Address - Phone:561-659-7411
Practice Address - Fax:561-659-7423
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0082320207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H78497Medicare UPIN
06116BMedicare ID - Type Unspecified